Norm of Rubin's Test (Uterotubal Insufflation)
Bilaterally patent fallopian tubes.
Normal patency: Pressure rises to 80–100 mm Hg and then decreases as carbon dioxide passes through the fallopian tubes.
Partial patency: Pressure rises to between 120 and 130 mm Hg.
Occlusion of tubes: Pressure rises above 200 mm Hg.
Usage of Rubin's Test (Uterotubal Insufflation)
Diagnosis of obstruction, stenosis, or stricture of the fallopian tubes; and detection of spasm of the uterine end of the fallopian tubes.
Description of Rubin's Test (Uterotubal Insufflation)
Rubin's test involves transuterine fallopian tube insufflation with carbon dioxide. A flowmeter and pressure gauge are attached to the source of the carbon dioxide. Changes in pressure are recorded on a kymograph. Displacement of adhesions and removal of debris from the tubes may occur during the procedure.
Professional Considerations of Rubin's Test (Uterotubal Insufflation)
Consent form NOT required.
Air embolism, hemorrhage, infection, and referred shoulder pain.
Infections of the cervix, fallopian tubes, or vagina; in suspected pregnancy; and with uterine bleeding.
- See Client and Family Teaching.
- An analgesic may be given 1 hour before the procedure to minimize tubal spasm from anxiety or discomfort.
- Obtain povidone-iodine solution, a vaginal speculum, cervical swabs, and a cervical cannula.
- The client should void.
- The client is placed in the dorsal lithotomy position, and the perineal area is cleansed with 1% povidone-iodine solution.
- The physician introduces a vaginal speculum and exposes the cervix.
- The cervix is swabbed.
- A sterile cannula with a rubber tip is inserted into the cervical canal.
- The cannula tip is pressed tightly against the cervical os to seal the opening and is secured with a tenaculum.
- A rest period of approximately 2 minutes permits relaxation of the fallopian tubes.
- 60 mL/minute of carbon dioxide (never air because of the risk of embolism) is administered into the uterus, and pressures are recorded by means of a kymograph.
- During insufflation, a swishing sound may be heard with a stethoscope as the carbon dioxide passes through the tubes.
- Shoulder pain caused by gas-induced subphrenic pneumoperitoneum is an indication of patency of at least one fallopian tube.
- Nausea, vomiting, cramping, dizziness, and pain associated with carbon dioxide gas absorption may be reduced by having the client rest for 2–3 hours with the pelvis elevated.
Client and Family Teaching
- This test will determine the patency of the fallopian tubes.
- Rubin's test takes approximately 30 minutes and is performed on an ambulatory care basis.
- You may be prescribed a laxative to take the night before the examination or may be given a suppository or enema before the procedure.
- Shoulder pain may be felt with insufflation.
- You may rest with the pelvis elevated for several hours to reduce discomfort secondary to gas absorption.
Factors That Affect Results
- Anxiety can cause fallopian tube spasm.
- This test is performed 4–5 days after the last day of menstruation.
- Because Rubin's test can ensure only that at least one fallopian tube is patent, it is of limited value.
- See also Hysterosalpingography.